2024 – You have recently joined New England HMO as a marketing analyst The HMO has

You have recently joined New England HMO as a marketing analyst. The HMO has been approached by a consortium. Your task is to develop the bid presentation to be made to the consortium.

Download and read the scenario. Download and use thespreadsheet for analysis.

Present your analysis as a 3-page report in a Word document formatted in APA style. Develop the bid presentation as a 6’7 slide PowerPoint presentation.

Name your documents as: LastnameFirstInitial_W1_A5.doc and LastnameFirstInitial_W1_A5.ppt.
For example, if your name is John Smith, your documents will be named SmithJ_W1_A5.doc and SmithJ_W1_A5.ppt.

 

 

Premium Development Case Study							A?© 2007 South University
New England HMO
Select the appropriate input values and enter them in cells containing hyphens or zeroes. Once you do this, the base case solution will appear.
Note that the historical cost input data for facilities services is the per deim reimbursement rate for inpatient acute care, the daily cost for skilled nursing facility care, the daily cost for inpatient mental health care, the per case cost for hospital-based surgery, and the per visit cost for emergency room services.
The historical utilization input data for facilities services is days per member acute care, nursing home care, and inpatient mental heatlh care; cases per member for inpatient surgery; and visits per member for emergency room care.
KEY INPUT:				KEY OUTPUT:
Inflation adjustment		0.0%		PMPM bid		$ 31.08
Administrative expense percent		0.0%		Premium rates:
Profit/reserves percent		0.0%		Single		$ –
				Family		$ –
OTHER INPUT AND MODEL-GENERATED DATA:
PMPM Calculation:
		Historical	Historical	Base	Copay Adjustment Factors		Adjusted	Inflation Adjusted
		Cost Data	Utilization	PMPM Cost	Cost	Utilization	PMPM Cost	PMPM Cost
I. Medical Expenses
Facility Services:
Inpatient:
Acute		$ –	0.0000	$ –	0.0000	0.0000	$ –
Skilled nursing		–	0.0000	–	0.0000	0.0000	–
Mental health		–	0.0000	–	0.0000	0.0000	–
Substance abuse				0.41	1.0000	1.0000	0.41
Surgical procedures		–	0.0000	–	0.0000	0.0000	–
Emergency room		–	0.0000	–	0.0000	0.0000	–
Outpatient procedures				3.43	1.0000	1.0000	3.43
Total facility services PMPM amount				$ 3.84			$ 3.84	$ 3.84
Physician Services:
Primary care				$ –	0.0000	0.0000	$ –
Specialist care
Office visits				–	0.0000	0.0000	–
Surgical services				9.00	0.9544	1.0000	8.59
All other services				23.67	0.8659	0.9100	18.65
Total physician services PMPM amount							$ 27.24	$ 27.24
Total medical PMPM amount								$ 31.08
II. Other Expenses
Administrative							$ –
Reserves							–
Total other expenses							$ –	$ –
Total PMPM amount								$ 31.08
III. Premium Rates
		Single	Family
	Rate factor	0.000	0.000
	Monthly premium rate	$0.00	$0.00